Fatih Dikici

A new osteotomy for the prevention of prominent lateral condyle after cubitus varus correctional surgery-made possible by a 3D printed patient specific osteotomy guide: A case report

Highlights • Skeletal deformity surgery is a difficult procedure which requires meticulous planning.• Good results demand precise application of the surgical plan during the surgery.• 3D software helps to make precise surgical plans and design case specific surgical tools.• 3D printing of case specific tools renders surgery easy and precise.

Analysing the change of sagittal balance in patients with Lenke 5 idiopathic scoliosis

Objective The aim of this study was to evaluate preoperative and postoperative spinopelvic parameters and the influence of lowest instrumented vertebrae on sagittal parameters in Lenke 5 Adolescent Idiopathic Scoliosis (AIS) patients. Methods A total of 42 patients (37 females, 5 males; mean age: 16.71 ± 3.46 years) were included in the study. Preoperative and postoperative last follow up lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS) angles measured. By stopped fusion in L3, L4 or L5 we divided the group into three parts. Results Mean follow-up was 43 months. Preoperatively, the mean TK and LL were 36.8° and 55.3°. At the last follow up, the mean TK and LL were 27.1° and 49.0° degrees, respectively. Preoperatively, the mean PI, PT and SS were 53.3°, 16.1° and 37.4° degrees. At the last follow up, the mean PI, PT and SS were 52.7°, 19.9° and 33.0° respectively. Significant differences were observed for SS (p = 0.003), TK (p = 0.004), LL (p = 0.012) and PT (p = 0.013) postoperatively for all patients. According the L3 and L4 groups there is significant difference in SS, LL (p = 0.013) and PT (p = 0.018) which means a significant decrease occurs in SS and LL when the distal fusion level changes from L3 to L4 but significant increase in PT in L3 group to compensate spinopelvic change after surgery. Conclusion The selection of more distal level for fusion adversely affects the compensation mechanisms of sagittal balance in Lenke 5 AIS patients. Level of Evidence Level IV, Therapeutic study.

Influence of Distal Fusion Level on Sagittal Spinopelvic and Spinal Parameters in the Surgical Management of Adolescent Idiopathic Scoliosis

Study Design Retrospective analysis of adolescent idiopathic scoliosis. Purpose This study aimed to investigate the influence of distinct distal fusion levels on spinopelvic parameters in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior instrumentation and fusion surgery. Overview of Literature The distal fusion level selection in treatment of AIS is the one of milestone to effect on surgical outcome. Most of the paper focused on the coronal deformity correction and balance. The literature have lack of knowledge about spinopelvic changing after surgical treatment and the relation with distal fusion level. We evaluate the spinopelvic and pelvic parameter alteration after fusion surgery in treatment of AIS. Methods A total of 100 patients with AIS (88 females and 12 males) were retrospectively reviewed. Patients were assigned into the following three groups according to the distal fusion level: lumbar 2 (L2), lumbar 3 (L3), and lumbar 4 (L4). Using a lateral plane radiograph of the whole spine, spinopelvic angular parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were radiologically assessed. Results The mean age was 15±2.4 years, and the mean follow-up period was 24.27±11.69 months. Regarding the lowest instrumented vertebra, patients were categorized as follows: 30 patients in L2 (group 1), 40 patients in L3 (group 2), and 30 patients in L4 (group 3). TK decreased from 36.60±13.30 degrees preoperatively to 26.00±7.3 degrees postoperatively in each group (p=0.001). LL decreased from 52.8±9.4 degrees preoperatively to 44.30±7.50 degrees postoperatively (p=0.001). Although PI showed no difference preoperatively among the groups, it was statistically higher postoperatively in group 3 than in the other groups (p<0.05). In addition, in group 2, PI decreased from 50.60±8.74 degrees preoperatively to 48.00±6.84 degrees postoperatively (p=0.027). SS decreased from 35.20±6.40 degrees preoperatively to 33.40±5.80 degrees postoperatively (p=0.08, p>0.05). However, mean SS was significantly higher in group 3 (p=0.042, p<0.05). PT decreased from 15.50±7.90 degrees preoperatively to 15.2±7.10 degrees postoperatively. The positive relationship (28.5%) between LL and PI measurements was statistically significant (r=0.285; p=0.004, p<0.01). Furthermore, the positive relationship (36.5%) between LL and SS measurements was statistically significant (r=0.365; p=0.001, p<0.01). Conclusions When the distal instrumentation level in AIS surgery is below L3, a significant change in PT and SS (pelvic parameters) is anticipated.

Aarskog-Scott syndrome: An unusual cause of scoliosis

A 16-year-old boy who had been diagnosed previously as Aarskog-Scott syndrome (AAS), referred to our clinic with shoulder asymmetry for 1 year. Results of spine examination showed a 52° right thoracic curve at T3-T11. Surgery was planned, and T1–L1 posterior instrumentation and fusion were performed. After surgery, satisfactory correction was achieved, and during 10 years follow-up, the patient had no complaints. AAS is a X-linked genetic disorder with facial, genital, and skeletal manifestations. Scoliosis is not reported as a typical finding of AAS, and there is no reported case in the English literature. Due to mutation affecting the developing skeleton tissue, spinal deformities may develop. In our case, concave side fusion was seen at the deformity. Although we do not know any specific pattern of the scoliotic deformity of this syndrome, surgical correction of the deformity can be difficult because of the premature fusion at these levels.

Comparison of spinal sagittal parameters by time of day in a healthy working population: Do we bend during the day?

BACKGROUNDnProspective study.nnnOBJECTIVEnTo determine the change in spinal sagittal parameters which may occur throughout the day in healthy population.nnnMETHODSnThirty-five healthy hospital employees were enrolled in the study. Two standing left lateral orthoroentgenograms were obtained at 8.00 a.m and at 6.00 p.m. Six spinopelvic parameters were measured on the X-rays. Thereafter, the subjects were divided into two cohorts according to their BMI as low BMI and high BMI.nnnRESULTSnThirty-five subjects with a mean age of 25.97 ± 8.21 were evaluated. No significant change was found between morning and evening measurements for any of the parameters. Direct relationship was shown between thoracic kyphosis (TK) and lumbar lordosis (LL), lumbar lordosis and sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) minus lumbar lordosis, sagittal vertebral axis (SVA) and pelvic incidence minus lumbar lordosis. In addition an inverse relationship was found between sacral slope and pelvic tilt, sacral slope and pelvic incidence minus lumbar lordosis, thoracic kyphosis and pelvic incidence minus lumbar lordosis, sacral slope and pelvic tilt, sagittal vertebral axis and lumbar lordosis (p< 0.05). Sagittal vertebral axis were found to be higher in the high BMI group, and daily change was lower but the differences were not statistically significant. Only the change in pelvic tilt value was found to be statistically significant in low BMI group.nnnCONCLUSIONnRoutine workload in a hospital environment does not cause significant change in the spinopelvic parameters throughout the day.

Postoperative changes in sacropelvic junction in short-segment angular kyphosis versus Scheuermann kyphosis

PurposeTo comparatively evaluate the biomechanical alterations those occur in the sagittal plane of sacropelvic junction in angular kyphosis (AK) and Scheuermann kyphosis (SK) patients after surgery.MethodsThe spine radiographs of 52 patients operated for short-segment AK (nxa0=xa020) or SK (nxa0=xa032) were studied. Main outcome measures were sacral slope, pelvic incidence, pelvic tilt, lumbar lordosis, and thoracic kyphosis angles.ResultsIn AK group, local and thoracic kyphosis angles, as well as lumbar lordosis angle, showed statistically significant reduction with surgery. Thoracic kyphosis and lumbar lordosis angles were reduced significantly in SK group. Postoperatively, there were significant differences between groups in lumbar lordosis, pelvic tilt angle, and sacral slope (pxa0=xa00.021, pxa0=xa00.001, and pxa0=xa00.027, respectively). Thoracic kyphosis angle and sacral slope were increased, and there was a remarkable correlation between thoracic kyphosis and lumbar lordosis values in the AK group.ConclusionsThe results of this study suggest that a significant sacropelvic improvement can be achieved by balanced sagittal vertical axis and T1 spinopelvic leading to a good sagittal alignment of spine in patients with AK and SK. Changes seen in morphological parameters after surgery may be closely related with baseline biomechanics and structure of the spine and pelvis. Therefore, further clinical and scientific trials are necessary both to elucidate the biomechanics, their clinical implications, and to develop new techniques and models for spine and pelvis surgery.

Selection of distal fusion level in terms of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods

Objective The aim of this study was to investigate the effect of distal fusion level selection on the distal junctional kyphosis (DJK) in Scheuermann kyphosis (SK) patients who underwent posterior fusion. Methods Thirty-nine SK patients who underwent posterior fusion with a minimum follow-up of 3 years were retrospectively evaluated. According to the distal fusion level, patients were divided into 3 groups. Group S; lowest instrumented vertebra (LIV) was the sagittal stable vertebra (SSV), Group F; LIV was the first lordotic vertebra (FLV) and, Group L; LIV was the lower end vertebra (LEV). DJK was evaluated according to distal level selection. Results Thoracic kyphosis (TK) decreased from 73.3° (SD ± 7.9°) to 39° (SD ± 8.7°) postoperatively, with a mean correction rate of 46% (SD ± 13) (p < 0.0001). In 11 patients, FLV and SSV was the same vertebra. In remaining 28 patients, 10 patients were in Group S, 15 patients were in Group F and 3 patients were in Group L. In Group S, none of them developed DJK, however, DJK was observed 9 of 15 patients in Group F. DJK was developed in all cases in Group L. There is a statistically higher risk for developing DJK when FLV or LEV was selected as LIV (p < 0.05). Conclusion Selecting SSV for the distal fusion level has been found to be effective for preventing DJK. Selecting distal fusion level proximal to SSV will increase the risk of DJK which may become symptomatic and require revision surgery. Level of evidence Level IV, therapeutic study.

Autologous segmental tibia bone transfer in the treatment of distal tibia Gustilo-Anderson type-III open fracture: A case report.

Highlights • Specific treatment modalities still remain a challenge in tibia fractures with bone and soft tissue loss.• Several treatment methods may be required in tibia fractures due to the poor coating of soft tissue.• The traditional treatment in open crus fractures with bone and soft tissue loss may cause miscellaneous complications.• Bifocal compression-distraction osteogenesis with an external fixator may be a salvage procedure to avoid complications of traditional methods.• The osteosynthesis with autologous tibia bone transfer may be employed by saving the segment inside abdominal wall, if suitable conditions are provided.

Comparison of fixation techniques in Vancouver type AG periprosthetic femoral fracture: a biomechanical study.

OBJECTIVEnThe purpose of this study was to biomechanically compare cable, trochanteric grip plate, and locking plate techniques in Vancouver type AG fracture model in an in vitro test environment.nnnMETHODSnFifteen pieces of fourth-generation synthetic femora were separated into 3 groups of 5 models each. A greater trochanteric fracture model was created after femoral stem implantation. Group 1 was fixated with only cable, Group 2 with trochanteric grip plate, and Group 3 with locking plate. Horizontal stiffness, axial stiffness, and failure loads were compared between the groups.nnnRESULTSnIn horizontal compression tests, Group 3 had the highest values, but the only statistically significant difference was between the locking plate group and cable group. Axial distraction test results showed that mean stiffness of Group 1 was 94.6±9.44 N/mm, that of Group 2 was 174.8±28.64 N/mm, and that of Group 3 was 185.6±71.64 N/mm. While locking plate versus cable fixation and grip plate fixation versus cable fixation showed statistically significant differences (p<0.05), comparison of locking plate versus grip plate fixation showed no statistically significant difference (p>0.05). In axial failure load test, Group 3 had the highest results. The only significant difference was between the locking plate and cable groups (p<0.05).nnnCONCLUSIONnIn Vancouver type AG fractures stable fixation may be achieved with grip plate fixation and locking plates, with the former ensuring more stable osteosynthesis.